A pin in the ear

In 1859 The Medical Times and Gazette included this report from John Robert Kealy, a surgeon from Gosport. He relates how a patient stuck a pin in her ear – and recovered it through her mouth twenty-four hours later:

About six o’clock on a Monday evening in last month, I was requested to attend immediately at the house of Mr. —, one of whose daughters, aged 19, had, while at the toilette table, put a pin into her left ear to relieve an intolerable itching.

Not recommended, for obvious reasons.

Her fingers being wet, the pin escaped her hold, and in order to get it out she pushed her little finger into the ear, and so made bad worse. I found the parts about the meatus [the opening of the ear] excessively tender; and she being of an hysterical temperament, the examination of the ear was extremely difficult. Having failed to discover the pin, and wishing to get rid of the cerumen [ear wax], I used an ear syringe. Without my asking her the question, she informed me that the liquid was passing into her throat; thus showing the membrana tympani to be perforated.

The eardrum (tympanic membrane) usually prevents liquids entering the ear from passing down the Eustachian tube, the channel between the middle ear and the throat. The ingress of fluid proved that the pin had punctured the membrane.

There was sharp, pricking pain between the mastoid process and ramus of the jaw.

Just behind the jaw, in other words.

I prescribed for her generally and topically, and at a subsequent visit determined to wait the result by the morning. About eight o’clock on Tuesday morning I visited my patient; found she had had a restless night, with increased pain and a stronger sensation of pricking on the left side of the throat. Hoping the pin was finding the point of exit, I directed her how to manage in order to secure it should she have the opportunity. I left for breakfast, but in a few minutes was quickly summoned to attend. On entering the room, the astonished friends produced the pin, of the size and angle indicated by this sketch.

The pin, as coughed up by the patient

It seems that, acting upon my instructions, she got her nail round the head of the pin; this excited reflex action, so that in an effort at retching, out came the pin, to the sufferer’s marvellous delight. The throat was somewhat inflamed, and a small quantity of blood was discernible. A gargle was ordered, and a continuance of the treatment. Next day symptoms of inflammatory action in the middle ear had increased, so that I was obliged to order leeches to be applied; these had the desired effect. Subsequently a blister was applied behind the ear, in order to relieve the continued pain.

The leeches and blister probably had little or no effect; the inflammation might have subsided without any medical intervention.

September 12th.—Upon examination by means of the otoscope, I find the membrana tympani opaque, and posteriorly a depression, in which is a hole about the size of a pin. She hears my watch at a distance of about two inches.

Mr Kealy concludes by reporting that two of the girl’s close relations had experienced something similar. Were the whole family in the unwise habit of sticking pins in their ears to relieve itching?

The mother of my patient is deaf from loss of the membranes tympanorum; and not long since I attended another daughter, who became completely deaf from suppurative inflammation of the external meatus, but has now perfectly recovered her hearing.